If your child is limping in the morning, it may be a sign of juvenile idiopathic arthritis (JIA). It’s a chronic, inflammatory disease that affects children’s joints.

Previously, the condition was known as juvenile rheumatoid arthritis (JRA) or simply juvenile arthritis (JA).

It causes joint swelling (inflammation) and joint stiffness in one or more joints.

There are not strong risk factors for developing JIA. A family history of JIA or rheumatoid arthritis (RA) can slightly increase the risk. Psoriatic JIA (psJIA) is more common in patients with a family history of psoriasis.

JIA can look similar to RA in adults, but differs from osteoarthritis (‘wear and tear’ arthritis), because it’s due to inflammation in the joints, rather than the wearing down of cartilage.

Juvenile idiopathic arthritis often develops around ages two to three or in the younger teenage years. It’s very rare to develop before one year of age, however, can develop at any age.

Symptoms of juvenile idiopathic arthritis

“Early in JIA, morning symptoms are some of the first to develop,” said Dr. Nicholas McClellan, pediatric rheumatologist with Marshfield Children’s. “This can look different at different ages.”

For example, toddlers may have a reluctance to walk in the mornings or after a nap, but improve after being up for a while.  Older children may limp in the morning, but find they feel better after walking around. However, symptoms may worsen with time and be present all day later.

Symptoms of JIA also can overlap with other conditions.

“Symptoms of JIA can look like injuries, overuse from sports and even infections,” said Dr. McClellan.

Older children may feel like they have a sprain that happens without injury or with a mild injury that doesn’t get better over time.

A persistent warm, swollen or tender joint that lasts for weeks may also be a symptom of JIA.

Diagnosing juvenile idiopathic arthritis

A diagnosis of JIA is typically made after discussing symptoms with your provider and a detailed examination of the joints. In most patients with JIA, labs are typically normal or show only mild inflammation.

In some cases, where the diagnosis is still unclear after an evaluation, tests such as X-rays, ultrasound or an MRI are required.

JIA treatments

Treatment is important to prevent or limit damage to the joints.

“The specific treatments can depend on the severity of inflammation and specific features of the arthritis and individual response to treatment,” Dr. McClellan said.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are often sufficient. Other patients may require stronger medications to limit inflammation and protect the joints. Some patients benefit from steroid injections into affected joints.

In patients with oligoarticular JIA, which means they have a small number of affected joints (less than four), NSAIDs and/or joint injections are tried first.

For patients with polyarticular JIA, which means they have a larger number of affected joints (more than four), medications such as methotrexate or other DMARDs (disease modifying antirheumatic drugs) are required.

Some patients may require medications known as biologics to control symptoms. These include medications such as adalimumab (Humira) or anakinra (Kineret).

Care after diagnosis

“Some patients will see their arthritis resolve with treatment and can stop the medications after a couple of years,” said Dr. McClellan. “Others may have times where the arthritis flares and needs medication but can have long periods off medication.”

Some patients may require lifelong treatment.

“Each patient is unique in their symptoms and their response to medications.”